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Endometrial hyperplasia – diagnosed on hysteroscopy; TVS is more accurate. Two types: simple (proliferative endometrium) or complex (proliferative endometrium with atypical changes and if left untreated will progress to cancer in 2 years); tx: high-dose progesterone with frequent reassessment; definitive tx: hysterectomy with oophorectomy Endometrial CA – 5thmost common cancer in women in Australia. Px complains of vaginal bleeding or irregular postmenopausal bleeding; (+) hx of anovulatory cycles or abnormal endometrial cells on pap; tx: surgical removal (Total hysterectomy àbilateral salpingo-oophorectomy àbilateral pelvic and para-aortic LAD àperitoneal cytology) and staging during surgery; good prognosis if diagnosis is made early; consider RT for deeply invasive tumor DYSMENORRHEA AND ABDOMINAL PAIN Dysmenorrhea Case: Mary is 14 years old presents to your GP clinic while her mother is outside in the waiting room. You know her for 6 years. She complained of severe central lower abdominal pain with her periods for the past few menstrual cycles. The pain gradually begins on day one of her menses and becomes very severe within a few hours. She gests nauseated and sometimes vomits and sometimes she feels a nagging ache at the top of her thighs
47when she gets the abdominal pain. Paracetamol does not relieve the pain. Yesterday her mom gave her strong analgesia with codeine (endone) which relieved the pain but she slept for the remainder of the day. Mary’s menarche was at 13 years of age. Her cycles were irregular for the first 6 months but now are regular every 28 days lasting about 7 days. She is otherwise well. Her mother suggested Mary to see you because she is concerned that the severity of pain might indicate that there is something serious with Mary. Task a.History (menses started yesterday, 1 pad/day, every 28 days, sexually active and uses condoms, not on OCPs) b.Physical examination c.Investigation d.Diagnosis and management -Ensure CONFIDENTIALITY at all times!!!!!! -Consent: olegal age: 18 y.o osexual activity: 16 y.o. omature minor: >12 y.o. -Scale PAIN! -Sexual history: are you sexually active? How long have you been active? Are you in a stable relationship? How long? How many sexual partners have you had? Do you practice safe sex? -SADMA? -Other bleeding problems Dysmenorrhea Differential diagnosis: Primary dysmenorrhea -Menstrual pain associated with ovular cycles without any pathologic findings; usually commences within 1-2 years after menarche and becomes more severe with time up to about 20 years. -50% of women and up to 95% of adolescents -Features: oLow midline abdominal pain oPain radiates to back or thighs oVaries from a dull dragging to a severe cramping pain oMaximum pain at beginning of the period oMay commence up to 12 hours before the menses appear oUsually lasts 24 hours but may persist for 2-3 days oMay be associated with nausea and vomiting, headache, syncope or flushing oNo abnormal findings on examination -Investigations: oMSU -Risk factors: oObesity oSmoking o